Preceptorship/Fellowship Applications

Preceptorship/Fellowship Applications

Complete all applicable sections of the application then scan and upload supporting documentation:

1. Personal Statement of Purpose: Please include your goals of completing this training and plans after completion of the program.

2. Official copy dental education transcript(s) from all colleges/universities attended translated into English

3. Official copy of transcript(s) from foreign universities and Canadian institutions where English was not the official language of instruction (if applicable).

4. Three (3) letters of reference from people with knowledge of the applicant's skills and potential

5. Provide evidence of English Language Proficiency or a TOEFL score of 550 or computer base score of 213 or internet based score of 79-80 is required of students from non-English speaking countries. (An interview may be required)

A waiver request may be submitted as part of your application. You may request a waiver if your degree (minimum two years' duration) was conducted exclusively in English, or you have lived or worked in an English-speaking country for at least two years since graduation. Click here for form.

6. Curriculum vitae (if applicable)

7. Non-refundable application fee of $250 USD (please email cde@ucsf.edu for link to application fee). Please note: Applicants will be considered only after this application and all other items are received by UCSF School of Dentistry, Office of Continuing Dental Education.

Today's Date*

Program*

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Module*

Note: For applicants who require a J-1 Visa, please note that the start date can vary.

J1 Eligibility Requirements - Applicable to candidates who do not possess permanent resident, a green card, a H-4 or J-2 visa.

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AEGD Virtual Program Start Date

Only used for those who apply for the AEGD Virtual Program

First Name*

Middle Name

Surname*

Suffix*

For example, BDS, MS, DDS, etc.

Email Address*

Gender*

Select

Telephone*

(Country/Area Code) Number

Phone

Home Address*

Street, City, State, Mail Code, Country

US Address*

If not applicable, please put NA.

Date of Birth*

Place of Birth*

Marital Status*

Number of Children*

I have/ I am a:*

Select or enter value

If you live in the United States, what current Visa do you have?*

Enter N/A if not applicble

Language(s) Spoken*

Education

Institution - Dates Attended (From | To) - Major & Minor Fields - Degree & Date*

List colleges, universities, graduate and professional schools at which credit have been earned.

Experience

Teaching*

Please describe nature of work and dates attended. If this doesn't apply, please enter N/A.

Private Practice*

Please describe nature of work and dates attended. If this doesn't apply, please enter N/A.

Scholarships, Prizes, Honors, or Other Recognition

Personal Statement*

A statement describing your general interests.

1) Your reasons for seeking advanced training and education in dentistry.

2) Your career goals and plans for practice, research, teaching, community health programs, etc.

3) The type of program you feel would best suit your needs. (i.e. university and/or hospital)

4) Any additional information you feel is pertinent in considering your application. (If you need more space, upload your statement)

File Upload

Official dental education transcripts translated into English (Copy okay)

Three (3) letters of reference from people with knowledge of the applicant's skills and potential

Provide evidence of English Language Proficiency or a TOEFL score of 550 or computer base score of 213 or internet based score of 79-80 is required of students from non-English speaking countries. (An interview may be required)

Curriculum vitae (if applicable)

Official TOEFL (Test of English as a Foreign Language) scores. (Copy okay)Test is required for those applicants whose native language is not English and have not attended a US institution for at least one year. A waiver is available upon request.

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